Immigration and Nurses - Why Africa is watching the U.S. Senate

If U.S. immigration reform plays out the way U.S. Sens. Edward Kennedy and John McCain would like it to, don’t be surprised if some African countries slap a ban on the emigration of nurses and other health professionals when that reform kicks in.

What does the one have to do with the other? It’s called the H-1B visa, a highly coveted stamp in a non-U.S. passport that allows the passport’s owner to legally enter the United States and work. H-1B is a non-immigrant classification. Its bearer is employed temporarily in a specialty occupation—architecture, engineering, medicine, education, accounting, law, theology, the arts—or, yes, as “a fashion model of distinguished merit and ability.” Immigration law establishes an annual quota for H-1B visas—65,000 for the current fiscal year, which ends September 30.

It’s not easy to obtain H-1B status. According to U.S. Citizenship and Immigration Services, a sponsoring U.S. employer first must file a labor condition application (LCA) with the Department of Labor attesting to several items, including payment of prevailing wages for the position and the working conditions offered. The employer files the certified LCA with a Form I-129 petition, plus a fee of $130. H-1B status generally is granted for no more than six years at a time, although that period may be extended in certain cases. The maximum period for certain aliens working on Defense Department projects is 10 years. At the end of the maximum period, an alien must remain outside the United States for one year before another H-1B petition can be approved.

In 2004, 66,309 immigrants entered the United States legally from Africa, fewer than from any other region except Oceania—Australia, Guam, Fiji, New Zealand, Papua New Guinea, Samoa are among the nations of Oceania—from where slightly more than 5,900 emigrated legally to the United States. The same year, 4,363 holders of non-immigrant H-1B visas came in from Africa, including 925 from Nigeria, 886 from Egypt, 553 from Ghana and 154 from Kenya.

Little love is lost between African governments and H-1B, which is why they are glued to the current immigration ruckus in the United States and the likely fallout on the H-1B quota. At the heart of their angst is the exodus of highly skilled workers, particularly those from the shortage-beleaguered health sector. Zambia’s president, Levy Mwanawasa, for example, recently traveled to Britain for medical treatment partly due to inadequate health staff in his country. And Uganda’s minister for primary health care says the country could run out of health workers if the health work force crisis is not addressed immediately.

Last year, Massachusetts Democrat Kennedy and Arizona Republican McCain, two of the country’s more open-minded senators, co-sponsored the loftily titled “Secure America and Orderly Immigration Act,” setting off a wave of teeth grinding in Africa. Under the Kennedy-McCain bill, undocumented workers and their families can apply for a work visa, pay a $1,000 fine and after six years of working—or six years of schooling for students—file for legal permanent resident status. More troubling for Africa, the bill doubles the number of employment-based visas. With the United States experiencing its own severe nursing shortage, the Senate is seriously considering allowing in an unlimited number of nurses as part of the wider debate on immigration policy.

Kenyans have raised the loudest voice in dismay. It’s bad enough, though understandable, that nurses have been emigrating to Britain, where it’s easier to get a work permit than in the United States, they say. “With their low wages, dangerous working conditions and scarce medicine and supplies, African nurses have good reasons for leaving, but their [emigration] will leave behind more suffering,” Isabella Mbai, head of the department of nursing sciences at Moi University, wrote in a letter published in April in The Washington Post. But it would be worse if lawmakers lift the cap that currently allows a maximum of 500 nurses a year from Africa and other countries to take jobs in the United States. “Solutions to the U.S. nursing shortage shouldn’t come at the cost of African lives,” Mbai declared.

Health Ministry statistics show just one doctor for every 100,000 people in Kenya and 49 nurses per 100,000—well below the World Health Organization’s recommended ratio of one health professional per 5,000 persons. In a preemptive strike, the Kenyan government announced plans to employ 3,800 medical personnel by June, including nurses, laboratory technicians and clinical officers, to help close a gap of 7,000 workers. Other countries likely will follow suit. Stanching the drain to the West, however, will take much more than new hiring.